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2024, Number 2

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Rev Mex Traspl 2024; 13 (2)

Tuberculosis in an allogeneic transplant kidney: a case report and review of literature

Acevedo-Quijano DS, Fuentes L

Language: Spanish
References: 25
Page: 92-97
PDF size: 250.37 Kb.


ABSTRACT

There are around 1.7 billion people worldwide with latent Mycobacterium tuberculosis infection (LTBI). All kidney transplant recipients and their donors should be screened for LTBI and active tuberculosis disease prior to transplant. The incidence in post-transplant patients is higher than the general population. There is no gold standard test to accurately diagnose LTBI. The WHO recommends three tests for the detection of LTBI: the tuberculin skin test (TST) and two interferon gamma release assays (IGRA), namely QuantiFERON1-TB (QFT) Gold In-Tube and T-SPOT1 T ( WHO, 2018b). The TST can be unreliable in patients with advanced chronic kidney disease and in those taking immunosuppressive agents. Tuberculosis in the renal graft is a rare pathology, clinically it lacks the classic picture of constitutive syndrome, most of the time the patient presents a negative tuberculin test and negative results in cultures. This case presented in a 30-year-old male with hematuria, sterile pyuria, persistent low back pain, seven years after kidney transplantation, donor and recipient with no history of contacts with tuberculosis and with negative PPD tests. The main causes of hematuria were addressed, ruling out viral, urological and oncological causes. A simple CT scan documented extrapulmonary tuberculosis (spinal column) and due to renal function deterioration, Gene Xpert was performed on urine and a renal biopsy was decided due to proteinuria in the subnephrotic range and active sediment, concluding a diagnosis of tuberculosis of the renal graft, causing its loss. Renal graft tuberculosis is a potential cause of graft dysfunction and loss, requiring a high index of suspicion for diagnosis. Timely detection and early institution of therapy may help renal allograft survival. The treatment represents a challenge for the clinician due to the interaction of antifungal drugs with immunosuppressants of the transplanted patient.


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